title: Does obesity confer an increased risk and/or more severe course of post-ERCP pancreatitis?: a retrospective, multicenter study.
abstract: BACKGROUND
  Pancreatitis is the most common major complication of endoscopic retrograde cholangiopancreatography (ERCP). Recent studies have suggested that obesity may serve as a prognostic indicator of poor outcome in non-ERCP-induced acute pancreatitis. However, to our knowledge, no one has ever investigated the potential association of obesity and ERCP-induced pancreatitis. Thus, the purpose of our study was to determine whether obesity conferred an increased risk and/or more severe course of post-ERCP pancreatitis.
  
  
  METHODS
  A 160 variable database was prospectively collected by a defined protocol on patients undergoing diagnostic or therapeutic ERCP at 15 centers in the Midwest Pancreaticobiliary Group and participating in a randomized controlled study, evaluating whether prophylactic corticosteroids reduces the incidence of post-ERCP pancreatitis. Body mass indices (BMIs) were available on 964 of the 1115 patients from the original study. A BMI > or = 30 kg/m2 was defined as obese (World Health Organization) and used as a cutoff point in this study. BMIs were analyzed in a retrospective fashion to determine whether obesity confers an increased risk and/or more severe course of post-ERCP pancreatitis. Data were collected before the ERCP, at the time of procedure, and 24 to 72 hours after discharge. Standardized criteria were used to diagnose and grade the severity of postprocedure pancreatitis.
  
  
  RESULTS
  Nine hundred sixty four patients were enrolled in the study. Pancreatitis occurred in 149 patients (15.5%) and was graded as mild in 101 (67.8%), moderate in 42 (28.2%), and severe in 6 (4.0%). The patients were categorized by BMI (kg/m2) using the following breakdowns: BMI < 20, 20 to < 25, 25 to < 30, and > or = 30, as well as BMI < 30 or > or = 30. The groups were similar with respect to the patient and procedure risk factors for post-ERCP pancreatitis except the group with BMI > or = 30 had a higher frequency of females, were younger, had less frequent chronic pancreatitis, a lower number of pancreatic duct injections, and fewer patients received more than 2 pancreatic duct injections. Of the patients with a BMI < 30, 119 (16.4%) developed post-ERCP pancreatitis compared with 30 (12.5%) of those with a BMI > or = 30 (P=0.14). There was no association between the presence of obesity and the severity of pancreatitis (P=0.74). Patients with a BMI < 20, 20 to < 25, 25 to < 30, and > or = 30 had a similar incidence of post-ERCP pancreatitis.
  
  
  CONCLUSIONS
  Obesity did not seem to confer an increased risk for ERCP-induced pancreatitis. A statistically significant association between obesity and the severity of ERCP-induced pancreatitis was not apparent.
authors.affiliation: Indiana University Medical Center, Indianapolis, IN 46202, USA.
authors.forename: Viju P
authors.initials: VP
authors.lastname: Deenadayalu
authors.forename: Urszula
authors.initials: U
authors.lastname: Blaut
authors.forename: James L
authors.initials: JL
authors.lastname: Watkins
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Barnett
authors.forename: Martin
authors.initials: M
authors.lastname: Freeman
authors.forename: Joseph
authors.initials: J
authors.lastname: Geenen
authors.forename: Michael
authors.initials: M
authors.lastname: Ryan
authors.forename: Harrison
authors.initials: H
authors.lastname: Parker
authors.forename: James T
authors.initials: JT
authors.lastname: Frakes
authors.forename: Evan L
authors.initials: EL
authors.lastname: Fogel
authors.forename: William B
authors.initials: WB
authors.lastname: Silverman
authors.forename: Kulwinder S
authors.initials: KS
authors.lastname: Dua
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Aliperti
authors.forename: Paul
authors.initials: P
authors.lastname: Yakshe
authors.forename: Michael
authors.initials: M
authors.lastname: Uzer
authors.forename: Whitney
authors.initials: W
authors.lastname: Jones
authors.forename: John
authors.initials: J
authors.lastname: Goff
authors.forename: M'hamed
authors.initials: M
authors.lastname: Temkit
authors.forename: Glen A
authors.initials: GA
authors.lastname: Lehman
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D010195:Pancreatitis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D011241:Prednisone / Q000627:therapeutic use; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D011241:Prednisone